MEDICARE: JOEL M ROSENBERG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	167087	NY
2	208600000X	Surgery Physician	167087	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336143155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL M ROSENBERG MD

Provider Business Mailing Address
First Line	:	PO BOX 2337
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13220-2337
Country	:	US
Telephone Number	:	315-701-5607
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 PROSPECT AVE
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13203-1807
Country	:	US
Telephone Number	:	315-329-7001
Fax Number	:	315-329-7025

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/01/2013

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